Efficacy of Fluvoxamine as a Treatment for Behavioral Symptoms in Frontotemporal Lobar Degeneration Patients

Ikeda, Manabu; Shigenobu, Kazue; Fukuhara, Ryuji; Hokoishi, Kazuhiko; Maki, Naruhiko; Nebu, Akihiko; Komori, Kenjiro; Tanabe, Hirotaka

doi:10.1159/000076343

Cited by 91 publications

(63 citation statements)

References 23 publications

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“…118 In an open label study with fluvoxamine, improvement in the stereotypy inventory (p< 0.01) and NPI (p<0.05) were noted. 119 For the management of cognitive symptoms related to FTD, several open label studies have demonstrated benefit in patients who were treated with NMDA antagonist (memantine) with doses up to 20mg/day. 120 In an open label study of 16 121 However a recent RCT of 81 patients did not demonstrate a clear benefit with NMDA antagonist (memantine).…”

Section: Frontotemporal Dementiamentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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Section: Frontotemporal Dementiamentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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“…The change in the total NPI pre-and post-treatment was compared with a random effects model as previously described. 7 Some studies used the 10-item NPI, 8,9 and some used the 12-item NPI. [10][11][12][13] However, when these studies were grouped separately in the meta-analysis, the difference in the average NPI difference was minimal (−15.5 vs −15.2) and so these two groups were combined for the reported meta-analysis.…”

Section: Meta-analysismentioning

confidence: 99%

A systematic review of neurotransmitter deficits and treatments in frontotemporal dementia

2006

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Objective-To evaluate neurotransmitter deficiencies and neurotransmitter-based treatments for frontotemporal dementia (FTD).Methods-The authors conducted a systematic review of the literature on the mechanism and treatment of FTD and a meta-analysis of treatment studies of antidepressants for the behavioral symptoms of FTD.Results-Patients with FTD show deficiencies in the serotonin and dopamine neurotransmitter systems, while the acetylcholine system appears relatively intact. Antidepressant treatment significantly improves behavioral symptoms in FTD, but most studies are small and uncontrolled. Serotonergic treatments appear to improve the behavioral but not cognitive symptoms of FTD.Conclusions-Studies of neurotransmitter deficiencies in frontotemporal dementia (FTD) can be helpful in developing treatments. Treatment studies on FTD are scarce, given the prevalence and severity of this illness. Larger, well-controlled treatment studies are required to reach more definitive conclusions about treatment efficacy. Multicenter studies are likely the best way to complete treatment studies in a timely manner.Frontotemporal dementia (FTD) is increasingly recognized as an important cause of dementia. 1 The symptoms of FTD include behavioral symptoms such as disinhibition, inappropriate social behavior, and apathy. Other symptoms include language and executive dysfunction. 2,3 The behavioral symptoms of FTD can be difficult to manage for caregivers and clinicians.The paucity of pharmacologic trials for FTD is likely due to the only recent clinical definition of the illness, limitations in understanding the biology of FTD, and the difficulty of assembling well-characterized groups of patients.

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“…The serotonergic and dopaminergic functions were decreased in the hypothalamus and frontal and temporal lobes in FTD [11,12,[15][16][17] and serotonin dysfunction could correlate with food preferences for bananas, or sweet cravings, obsessive-compulsive behavior, disinhibition and aggression [18][19][20] , in addition to depression, irritability and apathy [13,21,22] . SSRIs have been tried in an open-label (OL) application in FTD patients, improving some of the obsessive symptoms [23][24][25] , but a placebo-controlled trial of paroxetine was negative and even found deterioration of cognition [26] . Serotoninergic trazodone has been found to be efficacious in a placebo-crossover design to improve behavior in FTD [27] .…”

Section: Galantamine In Frontotemporal Dementia and Primary Progressimentioning

confidence: 99%

Galantamine in Frontotemporal Dementia and Primary Progressive Aphasia

Kertesz¹,

Morlog²,

Light³

et al. 2008

Dement Geriatr Cogn Disord

192

103

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Background/Aims: The treatment of frontotemporal dementia (FTD) has been mainly symptomatic. Small randomized or open-label case control studies of neurotransmitters have been inconclusive. We tried galantamine in the 2 most common varieties of FTD. Method: Thirty-six behavioral variety FTD and primary progressive aphasia (PPA) patients were treated in an open-label period of 18 weeks and a randomized, placebo-controlled phase for 8 weeks with galantamine. The primary efficacy measures were the Frontal Behavioral Inventory, the Aphasia Quotient of the Western Aphasia Battery, the Clinical Global Impression of Severity and the Clinical Global Impression of Improvement. Results: No significant differences in behavior or language were found for the total group. A treatment effect (p = 0.009), in a subgroup of subjects with PPA in the global severity score, in favor of galantamine was detected in the placebo-controlled withdrawal phase but was not considered significant after correction for multiple comparisons. The language scores for the treated PPA group also remained stable compared to the placebo group, which showed deterioration. Conclusion: Galantamine is not effective in the behavioral variety of FTD, but a trend of efficacy is shown in the aphasic subgroup, which may be clinically significant. Galantamine appeared safe in FTD/PPA.

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Efficacy of Fluvoxamine as a Treatment for Behavioral Symptoms in Frontotemporal Lobar Degeneration Patients

Cited by 91 publications

References 23 publications

Systematic review of recent dementia practice guidelines

Systematic review of recent dementia practice guidelines

A systematic review of neurotransmitter deficits and treatments in frontotemporal dementia

Galantamine in Frontotemporal Dementia and Primary Progressive Aphasia

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